Contemporary management of thymic malignancies
Presented by Prof Dr Mariana Brandao (Institut Jules Bordet, Brussels, Belgium)
During the 2025 World Conference on Lung Cancer (WCLC), Prof Dr Mariana Brandao, a medical oncologist at the Institut Jules Bordet in Brussels, chaired an educational session on the contemporary management of thymic malignancies.
The first presentation addressed the challenges in classifying thymic malignancies. A key issue is that most biopsies are small, which often fails to capture the full heterogeneity of the tumor. Since the surgical and medical management of different thymic malignancies can vary significantly, missing this heterogeneity may have critical implications for treatment decisions.
The session then focused on surgical approaches, particularly the extent of surgery. While a complete thymectomy is generally easier to perform and carries fewer complications than a partial thymectomy, a recent publication in The New England Journal of Medicine suggested that partial thymectomy may be associated with longer overall survival. Despite these findings, complete thymectomy remains the preferred option for patients with more aggressive thymic malignancies.
Adjuvant radiotherapy after surgery is gaining traction in the management of patients with thymic carcinomas or thymomas. The session highlighted new, innovative radiation techniques that enable more targeted therapy delivery, resulting in a significantly lower risk of cardiac damage.
In the final part of the session, the medical management of thymic malignancies was discussed. The current standard of care remains platinum-based chemotherapy, although immunotherapy has shown promise in this setting. However, data suggest a high risk of immune-related adverse events, requiring caution when using immune checkpoint inhibitors. Notably, because thymic cells naturally express PD-L1, this molecule should not be used as a predictive marker in these patients. Additionally, anti-angiogenic therapies, such as ramucirumab or lenvatinib, have shown promising results in treating thymic malignancies. For the moment, however, these agents are not reimbursed in this indication in Belgium.
As a general conclusion, Prof Brandao underscores the need to concentrate the care for these rare diseases in high volume centers, involving a multidisciplinary team of specialists who have experience in the care for these patients.